For several BWHers, including Srini Mukundan, MD, PhD, of the Department of Radiology, being able to work with care providers at Northern Navajo Medical Center in Shiprock, N.M., and Gallup Indian Medical Center in Gallup, N.M., through the Brigham and Women’s Outreach Program with Indian Health Service (IHS) has been an educational and transformative experience they will always cherish.

Mukundan, who has trained IHS staff on-site in Shiprock and remotely from BWH, said his experiences with the program provide an antidote to burnout and remind him why he chose this path in medicine.

“The Outreach Program opportunities have been one of the greatest rewards of being a BWHer,” Mukundan said. “After meeting the wonderful patients and witnessing firsthand the work of our remarkable colleagues at Shiprock, it is clear how important the essence of the physician-patient relationship is, especially in light of the limited resources available in Shiprock.”

Since 2009, BWHers have collaborated with the Navajo Area IHS – the federal agency responsible for delivering medical and public health services to members of federally recognized Native American tribes in the region. Through the Brigham and Women’s Outreach Program with IHS, BWH faculty, nurses, trainees and other providers volunteer their time and expertise to provide specialized care and training – on the ground at IHS hospitals and through remote teaching – in rural New Mexico and Arizona. Continue reading “‘An Unbreakable Bond’: BWHers Partner with Indian Health Service Providers”→

Dr. Joia Mukherjee is an associate professor in the Division of Global Health Equity at Brigham and Women’s Hospital, and she has served as the Chief Medical Officer for Partners in Health since 2000. She recently published an undergraduate textbook titled, “An Introduction to Global Health Delivery.”This 12/21/17 blog post is from the Oxford University Press blog.

Policy makers, organization, and governments have worked side-by-side with people living with AIDS as part of a global social movement for three decades. The success of the movement for HIV treatment access not only garnered billions of dollars of new money for HIV treatment, but also served to shift the public health paradigm from prevention-only to the provision long-term treatment. This paradigm shift ushered in a new era in global health. One that has strengthened health systems and treated a variety of conditions from non-communicable diseases, women’s health, mental illness, and cancer. Stronger and more resilient health systems are the result. Adult, child, and maternal mortality have dropped in many of the world’s poorest countries. UNAIDS recently announced that as of 2017, 21 million people have received antiretroviral therapy—the life-saving medications that have transformed AIDS from a fatal disease to a manageable and treatable one. READ MORE>>

Brittany Stopa is a Clinical Research Regulatory Coordinator in the BWH Department of Neurosurgery, and holds a Masters of Public Health in Global Health. She is a contributor to the BWH Global Health Hub.

Dr. Joia Mukherjee is an associate professor in the Division of Global Health Equity at Brigham and Women’s Hospital, and she has served as the Chief Medical Officer for Partners in Health since 2000. She recently published an undergraduate textbook titled, “An Introduction to Global Health Delivery.”

“In stunned silence I watched Lovely die in front of me. Her bloated belly, red hair, and swollen feet screamed the medical diagnosis kwashiorkor, protein calorie malnutrition, starvation. The heartache, anguish, and even shame on her mother’s face pierced my psyche…Children do not die of starvation because of their mothers’ ignorance. Mothers know when their children are hungry from their ceaseless cries. They know when their children are dying of starvation when the crying stops. More than 25 years ago I first witnessed death from starvation. In my youth, my ignorance, and my relative solitude, I delivered only the prescribed guidance to Cynthia, and to other mothers. But I could not make sense of a world where a starving child was not offered food. I felt ashamed then and now at the gross inequity of a world with enormous wealth and starving children. Health disparities are a thermometer of injustice.”

This introduction to Mukherjee’s new textbook from Oxford University Press, An Introduction to Global Health Delivery, sets the tone for a publication that aims to reshape the field of global health and how it is taught. In it, she calls out the established set of practices in global health as failing the people they purport to serve. And Dr. Mukherjee calls for a new approach to global health delivery, one that is built on the premise that everyone has a right to health.Continue reading “Dr. Mukherjee’s New Textbook Will Reshape How We Teach Global Health Delivery”→

Ms. Stopa is a Clinical Research Regulatory Coordinator in the BWH Department of Neurosurgery, and holds a Masters of Public Health in Global Health. She is a contributor to the BWH Global Health Hub.

Dr. Neil Gupta is a physician in Brigham and Women’s Division of Global Health Equity (DGHE) who is working to strengthen healthcare systems by addressing the growing problem of noncommunicable diseases in low-income countries. I sat down with Dr. Gupta to discuss the scope of his work and the landscape in which he conducts these critical system-strengthening efforts.

Ms. Stopa: Thank you for joining me, Dr. Gupta. I want to talk to you today about noncommunicable diseases (NCDs) and your work in addressing them. I read in the World Health Organization (WHO) report in 2015 that 70% of the world’s 56 million deaths were caused by NCDs1. And so, as somebody that works in that field, do you see NCDs emerging as the focus of public health? Is this the direction the field is moving?

Dr. Gupta: NCDs are definitely an emerging focus in global health and are increasingly recognized as a critical issue that we need to address. NCDs, to give you an overview, are a diverse group of chronic illnesses that include cardiac conditions, cancers, respiratory diseases, diabetes, blood disorders, kidney diseases, liver cirrhosis, congenital diseases, and many other conditions. It can also include mental disorders and injuries, which may require surgical, rehabilitation, or palliative care services.

In the global health community, NCDs are set apart from more traditional infectious diseases, which have historically been a major focus in global health. Infectious diseases cause a huge number of deaths, but luckily many can now be prevented or treated with adequate tools and resources. Addressing large-scale infectious epidemics, as well as basic maternal and child health services, was the first goal of emerging health systems in lower income countries globally. But now, as health systems and coverage of health services have improved in those areas, the area of NCDs is being increasingly recognized as the next step for maturing health systems.

On World Prematurity Day, findings from a new study will be published in the journal Pediatrics.1 This systematic review examines the accuracy of different newborn assessments to determine gestational age and identify preterm babies.

WHY THE EARLY IDENTIFICATION OF PRETERM BABIES IS IMPORTANT

Each year, 15 million babies are estimated to be born preterm (before 37 completed weeks gestation), with the vast majority born in low- and middle-income countries (LMICs).2 Preterm birth complications are the leading cause of under-5 child mortality globally3—accounting for 1 million neonatal deaths each year.4

Preterm babies are more likely to die in infancy or become ill with conditions that could be effectively treated if identified early, such as breathing problems, infections, or low body temperature. The early identification of preterm babies enables health workers to offer these babies special care, including better monitoring and the timely delivery of potentially life-saving interventions, such as continuous positive airway pressure or kangaroo mother care. Furthermore, accurate determination of gestational age is needed to identify growth-restricted infants, who also carry increased risk of mortality and morbidity in infancy and beyond.

In 2009, BWH faculty in the Division of Global Health Equity began a journey with colleagues in Rwanda, at Partners In Health and at HMS, to strengthen community health across the globe. That journey culminated this fall, with the publication of dynamic toolkits on MESH-QI and District Costing Methodologythat will allow the impact of this work to endure. Funded by the Doris Duke Charitable Foundation’s Africa Health Initiative, this ambitious work is coming to a successful conclusion and culminating with numerous publications, notably including two powerful toolkits that will allow this work to be replicated at many sites for years to come.

Dr. Lisa Hirschhorn and Dr. Peter Drobac were principal investigators on the Population Health Implementation Training project, which sought to make significant improvements to WHO health system building blocks. The project also worked to fulfill MOH priorities such as improving the quality of health center-based care, strengthening monitoring and evaluation, and enhancing community health worker networks.

Out of this grant and the vision of these leaders, Partners In Health has developed a model for mentoring health care workers. The model is gaining broad attention after improving quality of care in Rwanda and elsewhere for several years. The team also has developed a new guideline—along with a separate, cost-analysis toolkit—that describes how health centers and systems can implement the model, combat the global shortage of quality health care staffing and plan budgets across a range of services.

“Building a culture of high-quality care delivery processes and systems is almost impossible, especially in resource-limited settings,” said Anatole Manzi, director of clinical practice and quality improvement for PIH, who worked closely with Drs. Hirschhorn and Drobac on this project.

“This guide provides invaluable help to organizations and governments preparing to implement MESH-QI as a model for Health Systems Strengthening,” Anatole Manzi, director of clinical practice and quality improvement for PIH.

Dr. Naima Joseph is a Global Women’s Health Fellow at BWH. Through her research and clinical practice around issues of cervical screening, Dr. Joseph is contributing towards improving cancer related morbidity worldwide and improving healthcare for women.

On Kampala-Masaka road, approximately 420 kilometers from Kampala, Uganda’s capital city, lies the Equator. The Equator is in Kayabwe, a bustling village in Mpigi District, and is a known as a destination of sorts. There, you can conduct scientific experiments to estimate the Coriolis effect, or earth’s rotational forces on weather. You can weight yourself and find that you are one lb. lighter on either side. And of course, you can buy souvenirs, or a latte. My favorite stop along the Equator is a seemingly innocuous billboard that boldly proclaims, “You have rights to quality health care.”Continue reading “Partnership to increase access to Cervical Cancer Screening in Uganda”→

Brittany Stopa is a Clinical Research Regulatory Coordinator in the BWH Department of Neurosurgery, and she holds a Masters of Public Health in Global Health. She is a contributor to the BWH Global Health Hub.

The BWH Global Health Delivery Partnership Grand Rounds, offered monthly, are open to all staff and clinicians at BWH. I attended the September 2017 Grand Rounds where Dr. Salmaan Keshavjee captivated an audience of global health and health equity supporters with his talk about the Zero TB Initiative. In addition to his appointment as Associate Professor in the BWH Division of Global Health Equity, Dr. Keshavjee serves as Director of Harvard Medical School Center for Global Health Delivery-Dubai and Associate Professor in the Department of Global Health and Social Medicine, at Harvard Medical School.

Dr. Keshavjee had our attention immediately when he declared that there are 10.4 million new cases of tuberculosis (TB) each year, but only 6.1 million of them are diagnosed and treated. Further, 1.8 million of those cases result in death each year, making TB the biggest infectious killer of adults globally. That’s a staggering 4,000 people each day that die from TB, a disease that has been treatable since 1947.

“TB is the biggest infectious killer of adults globally. A staggering 4,000 people each day die from TB, a disease that has been treatable since 1947.”

Through the Global Women’s Health/Family Planning Fellowship I have had the opportunity to work with Possible, a nonprofit organization in Nepal, on community-based interventions to improve uptake of postpartum contraception. With my colleague, Sheela Maru, who also completed the Fellowship I have recently focused on critical issues of access to family planning and safe abortion care.

In 2009 the Supreme Court of Nepal found that reproductive rights are considered to be an inseparable part of women’s human rights and within that, the right to abortion is seen to hold an important place.(Lakshmi Dhikta v. Nepal, Supreme Court of Nepal). Prior to 2002, Nepal had very restrictive abortion laws that prosecuted and imprisoned women and their family members for undergoing pregnancy terminations. Now 15 years after legalization, Nepal is an important case study on successful early implementation of safe abortion services, but persistent challenges exist in issues of access, equity, and quality.

“In 2009 the Supreme Court of Nepal found that reproductive rights are considered to be an inseparable part of women’s human rights.”

Dr. Ronald Warner is a primary care physician at Brigham and Women’s Faulkner Community Physicians in Hyde Park. He is President of the Brigham and Women’s Faulkner Medical Staff.

Dr. Warner and medical assistant Felecia Gooding collaborate at the Brigham and Women’s Faulkner Community Physicians in Hyde Park.

As a community physician in the Hyde Park office of Brigham and Women’s Faulkner Community Physicians, I see patients who were born and raised in Hyde Park as well as a large patient population from all over the world who have settled in the neighborhood. While global health often involves a physician traveling to other parts of the world, my patients come from across the city with deep roots to many countries. It’s an honor to connect with patients and their families, to understand the contexts of their lives outside the walls of our office.

Our patient population is a mix of individuals from very different backgrounds and for me personally it’s always interesting and important to hear how they came to us and what they’re doing. Marc and Monique are two of my patients who were born in Haiti and now live in Jamaica Plain. Their lives are not easy given their heath status. Marc has Parkinson’s disease and Monique has COPD. They both also have diabetes. Their complex medical conditions mean their health needs close monitoring. Luckily, their daughter Mirlande lives nearby and is able to help coordinate their care with my office and myself.